Category: Advancing Modules

Key points recap

Key points recap:

  • Ray feels he is using the strategies well and is finding the phased return manageable. He would like to increase his hours, but during the discussion it becomes clear that he is aware that he might not be ready yet. Ray reports finding the timetables and lesson plans for delivering lessons really helpful, and is relieved that he can use them again next term. He also is very grateful to have a teaching assistant in class with him, to allow him to step out of the classroom when required, which he has had to do. He is upset by the need to do this, and is hard on himself, and feels he should be fitter and less tired by now.
  • Ray describes finding it hard to manage when the class are all talking at the same time or when lots of pupils are needing his assistance at once, and he can feel like he doesn’t know where to start.
  • His daughter shares that she has heard other pupils making fun of her dad and how he takes jokes really literally and how you can make him do silly things because he doesn’t get sarcasm. They’ve also spoken about how they can make him easily lose his temper, which the pupils’ find amusing.
  • His daughter also talks about her dad not noticing when she is upset, or has had a bad day, which is very different to pre-stroke, when they used to chat about their day on the drive home from school.

Key Messages

  • Many people experience changes to their attention following a stroke.
  • The various types of attention are related to a number of different areas of the brain. Stroke can experience changes to some attention processes and not others.
  • Different tasks require different attention processes and valid assessment is essential to determine which processes require rehabilitation.
  • As Michael’s strengths and challenges with each attention type was identified, it was possible for a more attention-specific work rehabilitation programme to be developed.

Triangle of awareness

Awareness can be affected by damage to specific parts of the brain – e.g. The right posterior parietal lobe in visuospatial neglect, or global cognitive deficits can mean that the person cannot piece together and appreciate their difficulties, and for some, their maybe additional aspects of denial and a difficulty facing the painful changes that have occurred.

Key Messages

  • Memory problems are common after a stroke (57% at the point of discharge in a 2018 study by Surawan et al) but they can be confused with other conditions and cognitive impairments and careful assessment may be required. 
  • The location and side of the stroke can impact on the type of memory problems we see but difficulties with recent, declarative memory (facts and events we are consciously aware of) are most common. 
  • Memory impairments can have a significant impact on an individual’s quality of life and ability to engage in everyday tasks and activities. 
  • A wide range of rehabilitation strategies may be helpful but it is important that these are tailored to the individual, their situation, and their particular memory problems. 
  • It is also worth noting, that memory problems post stroke are rarely found in isolation. That is, they are often part of a complex constellation involving other cognitive, physical and emotional issues. 

Neuroanatomy of attention

There are many areas of the brain that are involved in attention and these frequently operate in coordination with each other. Please use the rollover to find out what the attention function of each area of the brain is responsible for.

 

Revisiting attention

In Core Competency module 16, we considered the function of four attention processes. Michael was able to address his challenges related to his ability to sustain and divide his attention during household tasks. However, when considering his return to work, we cannot assume that his current attentional ability is adequate to meet the demands of work-based tasks. Please use the rollover below to discover the possible impact of ongoing changes of attention.





Rehabilitation service reviews at 6-months​

During his review, Michael provided an update:​

He is now back to working full time and is enjoying being back at work which he describes as therapeutic. As well as managing his daily work tasks, he is enjoying having regular contact with his colleagues again. He is aware that there are times when his attention can fluctuate, but notifies his manager, who supports by offering break times as needed, but both feel that it is positive that these instances have decreased in frequency to around twice per month.​

​Jane is delighted that her Dad is managing well at both work and home, and he has recently started to have friends visit him at home again, and has a date scheduled for a driving assessment at the drivers assessment service

Programme to date​

Michael's house is very messy

  • Rehabilitation had gone well in hospital​
  • Stroke liaison nurse engages with Michael and Jane and occupational therapy assessment undertaken​
  • Challenges with sustaining and dividing attention were found to be limiting Michael’s household management​
  • A series of strategies were set up and Michael was managing his home situation with greater control​
  • He was thinking of returning to driving and getting back to work